The California Rural Indian Health Board (CRIHB) and its Indian owned and operated Tribal Health Programs (THP) have made it their goal to contribute to the improvement of the health status of American Indians and Alaska Natives (AIAN) in California. With this project, Information Technology Systems for Rural Indian Clinic Healthcare (ITS-RICH) three separate endeavors in health services research, clinic redesign and electronic practice management will become integrated into a single coordinated effort to reduce hospitalizations that are preventable through improvement in quality of care and reduction in medical and medication errors. CRIHB is partnering with three of its rural THP who have implemented electronic practice management to now implement electronic health records with clinical decision support systems. The IT systems that result will be used in conjunction with local hospitals to support the review of all hospitalizations for their preventability, to detect and track THP medical and medication errors, and to detect and track THP performance of clinical care according to standardized performance guidelines. The long-term healthcare goals of the ITS-RICH Project are: 1) to improve healthcare performance of THP clinics according to GPRA [unreadable] performance standards; 2) To reduce medical errors of users of THP clinics; 3) To reduce medication errors of users of THP clinics; and 4) To reduce preventable hospitalizations of users of THP clinics. To make progress towards these goals the project has four Specific Aims: 1) Integrate Electronic Health Record with Electronic Practice Management in clinic operations that include clinical decision support systems; 2) See that individual patient care systems are in place to identify and track changes in clinical performance according to standards, medical and medication errors, and hospitalizations of THP users; 3) See that the individual patient care data are integrated, reported and used for population health analyses; and 4) See that the population health analyses are reported and used for quality improvement of individual patient care. [unreadable] [unreadable]